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Swiss Medical Weekly Nov 2003Amiodarone is used increasingly in a number of cardiac conditions. Amiodarone is heavily iodinated and can cause thyroid dysfunction. The diagnosis of amiodarone-induced... (Review)
Review
Amiodarone is used increasingly in a number of cardiac conditions. Amiodarone is heavily iodinated and can cause thyroid dysfunction. The diagnosis of amiodarone-induced thyrotoxicosis remains difficult and more common causes of thyrotoxicosis need to be considered and excluded. Amiodarone has a significant side effect profile, which includes thyroid dysfunction. Amiodarone is an effective drug and its withdrawal may have significant impact on a patient's already fragile cardiac status. There are three different types of amiodarone-induced thyrotoxicosis (AIT) (I, II and mixed). Identification of the different subtypes of AIT allows a rational and appropriate management strategy to be chosen. Type I occurs in patients with underlying thyroid disease, whilst type II is thought to result from a destructive thyroiditis. Differentiation is based on clinical grounds together with investigations, which can include thyroid function test, radioiodine uptake scanning, measurement of interleukin-6 levels and colour flow Doppler sonography. Amiodarone should be discontinued in both types of AIT if the indication for its use is not a life-threatening cardiac condition. The management of type I centres around antithyroid drugs to control thyrotoxicosis and later consideration of more definitive treatment. Type II AIT responds to steroid therapy, although antithyroid drugs may be useful if symptoms are severe. Therapeutic options for refractory cases of AIT include surgery, radioiodine and plasmapheresis.
Topics: Adrenal Cortex Hormones; Amiodarone; Anti-Arrhythmia Agents; Antithyroid Agents; Humans; Thyroid Gland; Thyrotoxicosis
PubMed: 14745652
DOI: 10.4414/smw.2003.10296 -
Deutsches Arzteblatt International Apr 2018
Topics: Amiodarone
PubMed: 29789112
DOI: 10.3238/arztebl.2018.0297 -
Amiodarone for the treatment and prevention of ventricular fibrillation and ventricular tachycardia.Vascular Health and Risk Management Aug 2010Amiodarone has emerged as the leading antiarrhythmic therapy for termination and prevention of ventricular arrhythmia in different clinical settings because of its... (Review)
Review
Amiodarone has emerged as the leading antiarrhythmic therapy for termination and prevention of ventricular arrhythmia in different clinical settings because of its proven efficacy and safety. In patients with shock refractory out-of-hospital cardiac arrest and hemodynamically destabilizing ventricular arrhythmia, amiodarone is the most effective drug available to assist in resuscitation. Although the superiority of the transvenous implantable cardioverter defibrillator (ICD) over amiodarone has been well established in the preventive treatment of patients at high risk of life-threatening ventricular arrhythmias, amiodarone (if used with a beta-blocker) is the most effective antiarrhythmic drug to prevent ICD shocks and treat electrical storm. Both the pharmacokinetics and the electrophysiologic profile of amiodarone are complex, and its optimal and safe use requires careful patient surveillance with respect to potential adverse effects.
Topics: Administration, Oral; Amiodarone; Anti-Arrhythmia Agents; Humans; Infusions, Intravenous; Tachycardia, Ventricular; Ventricular Fibrillation
PubMed: 20730062
DOI: 10.2147/vhrm.s6611 -
Digestive Diseases and Sciences Apr 2024To describe hepatotoxicity due to amiodarone and dronedarone from the DILIN and the US FDA's surveillance database.
OBJECTIVE
To describe hepatotoxicity due to amiodarone and dronedarone from the DILIN and the US FDA's surveillance database.
METHODS
Hepatotoxicity due to amiodarone and dronedarone enrolled in the U.S. Drug Induced Liver Injury Network (DILIN) from 2004 to 2020 are described. Dronedarone hepatotoxicity cases associated with liver biopsy results were obtained from the FDA Adverse Event Reporting System (FAERS) from 2009 to 2020.
RESULTS
Among DILIN's 10 amiodarone and 3 dronedarone DILIN cases, the latency for amiodarone was longer than with dronedarone (388 vs 119 days, p = 0.50) and the median ALT at DILI onset was significantly lower with amiodarone (118 vs 1191 U/L, p = 0.05). Liver biopsies in five amiodarone cases showed fibrosis, steatosis, and numerous Mallory-Denk bodies. Five patients died although only one from liver failure. One patient with dronedarone induced liver injury died of a non-liver related cause. Nine additional cases of DILI due to dronedarone requiring hospitalization were identified in the FAERS database. Three patients developed liver injury within a month of starting the medication. Two developed acute liver failure and underwent urgent liver transplant, one was evaluated for liver transplant but then recovered spontaneously, while one patient with cirrhosis died of liver related causes.
CONCLUSION
Amiodarone hepatotoxicity resembles that seen in alcohol related liver injury, with fatty infiltration and inflammation. Dronedarone is less predictable, typically without fat and with a shorter latency of use before presentation. These differences may be explained, in part, by the differing pharmacokinetics of the two drugs leading to different mechanisms of hepatotoxicity.
Topics: Humans; Dronedarone; Amiodarone; Anti-Arrhythmia Agents; Dyphylline; Chemical and Drug Induced Liver Injury
PubMed: 38416280
DOI: 10.1007/s10620-023-08251-2 -
Clinical Cardiology Jul 1987This article attempts to provide an overview of the present knowledge of the pharmacokinetics of amiodarone and how this relates to the clinical usage of oral... (Review)
Review
This article attempts to provide an overview of the present knowledge of the pharmacokinetics of amiodarone and how this relates to the clinical usage of oral amiodarone. It is apparent that wide gaps still exist in our knowledge of amiodarone's pharmacokinetics in humans and the best fit for the observations following a single oral dose and chronic dosing is that of a three compartment model with body tissues acting as a large reservoir of the drug; hence the very large volume of distribution (greater than 5001). It remains unclear as to exactly when steady state is achieved except that full clinical efficacy for ventricular tachyarrhythmias may take several weeks following high oral dosing (about 15g). The drug's bioavailability is modest (approximately 40%) and excretion is minimal via the hepatic route. It is extensively metabolised in all tissues to desethylamiodarone, whose antiarrhythmic properties remain to be elucidated. This metabolite is found to parallel amiodarone's concentration in serum but its concentration is variable in tissues. The liver shows the highest, and body fat the lowest concentrations of desethylamiodarone. The minimal effective serum concentration has not been established with certainty, and the unique pharmacokinetics of this agent has made it difficult to perform dose-response studies, especially in life threatening arrhythmias. Similarly, the toxic serum concentrations have not been established though it appears that a higher incidence of side effects occurs if serum concentrations exceed 2.5 mg/l during chronic (steady state) therapy.
Topics: Amiodarone; Dose-Response Relationship, Drug; Humans; Tissue Distribution
PubMed: 3078155
DOI: No ID Found -
Frontiers in Public Health 2021Atrial fibrillation (AF) is one of the most common arrhythmias in clinical practice, which brings great economic burden to patients. This study evaluated the economics...
Atrial fibrillation (AF) is one of the most common arrhythmias in clinical practice, which brings great economic burden to patients. This study evaluated the economics of the new antiarrhythmic drug dronedarone and provides suggestions for allocation of health resources. Amiodarone was selected as the control group, and the Markov model of AF was established using nine states. The total cost and quality-adjusted life year (QALY) of dronedarone and amiodarone groups were calculated and compared. The incremental cost effectiveness ratio (ICER) value was calculated and compared with the willingness to pay (WTP) and the sensitivity analyses was conducted. For China's healthcare system, the ICER of the dronedarone group compared with the amiodarone group was RMB 81,741 Yuan/QALY, which is lower than the current recommended WTP (3 times GDP per capita). Sensitivity analyses showed that the model was robust, and the drug price of dronedarone significantly impacted the results. Compared with amiodarone, dronedarone is more economical in the Chinese healthcare system. However, due to the lack of data on the Chinese population for some parameters, the model needs further improvement and discussion. Real-world studies on the effects of dronedarone on Chinese patients with AF would be beneficial.
Topics: Amiodarone; Anti-Arrhythmia Agents; Atrial Fibrillation; China; Cost-Benefit Analysis; Dronedarone; Humans
PubMed: 34527654
DOI: 10.3389/fpubh.2021.726294 -
Nefrologia 2020
Topics: Amiodarone; Anti-Arrhythmia Agents; Humans; Male; Middle Aged; Plasmapheresis; Thyroiditis
PubMed: 31740153
DOI: 10.1016/j.nefro.2019.07.004 -
Cleveland Clinic Journal of Medicine Mar 1998Amiodarone is a potent and versatile antiarrhythmic. Despite side effects involving the lungs, heart, thyroid, and other organs, it is effective in the treatment of... (Review)
Review
Amiodarone is a potent and versatile antiarrhythmic. Despite side effects involving the lungs, heart, thyroid, and other organs, it is effective in the treatment of refractory atrial and ventricular arrhythmias and it has unique safety in patients with coronary disease and left ventricular dysfunction. This review discusses the evolving indications for amiodarone and management of toxicities and drug interactions.
Topics: Amiodarone; Anti-Arrhythmia Agents; Humans
PubMed: 9540249
DOI: 10.3949/ccjm.65.3.159 -
Medicine Feb 2019Amiodarone and acupuncture (AA) are commonly used to treat cardiac arrhythmia (CA). The objective of this systematic review is to assess the efficacy and safety of AA... (Review)
Review
BACKGROUND
Amiodarone and acupuncture (AA) are commonly used to treat cardiac arrhythmia (CA). The objective of this systematic review is to assess the efficacy and safety of AA for patients with CA.
METHODS
Randomized controlled trials (RCTs) of AA for CC will be searched from 9 databases including PubMed, EMBASE, Cochrane Library, Web of Science, Scopus, Chinese Biomedical Literature Database, China National Knowledge Infrastructure, VIP Information, and Wanfang Data from inception to February 1, 2019 without any limitations. Two reviewers will independently screen the relevant papers, extract data, and evaluate the risk of bias for each included study. RevMan 5.3 software will be used for meta-analysis. The primary outcome includes arrhythmic episodes (including time and frequency domain parameters). The secondary outcomes consist of health-related quality of life, oxygen saturation, and safety.
RESULTS
The protocol of this proposed study will provide evidence to judge whether AA is an effective treatment for patients with CA.
CONCLUSION
The findings of this proposed study will summarize the up-to-date evidence of AA for CA.
PROSPERO REGISTRATION NUMBER
PROSPERO CRD42019120962.
Topics: Acupuncture Therapy; Age Factors; Amiodarone; Anti-Arrhythmia Agents; Arrhythmias, Cardiac; Combined Modality Therapy; Humans; Quality of Life; Randomized Controlled Trials as Topic; Research Design; Sex Factors
PubMed: 30762798
DOI: 10.1097/MD.0000000000014544 -
Biomedical Papers of the Medical... Jun 2017Amiodarone is the most effective agent in the therapy of arrhythmias. However, the clinical effect of acute and chronic treatment is unclear and there are differences...
Amiodarone is the most effective agent in the therapy of arrhythmias. However, the clinical effect of acute and chronic treatment is unclear and there are differences irrespective of comparable plasma/myocardial amiodarone and its metabolite desethylamiodarone concentations as well. Its unusual pharmacokinetics results in interindividual variation in plasma levels. The association between amiodarone and desethylamiodarone plasma levels and clinical efficacy is difficult to evaluate. This review was carried out to assess whether there is any objective correlation between amiodarone and desethylamiodarone plasma levels and the clinical effect. We summarized the results of relevant studies and clarified the relationship between plasma levels and effect vis á vis the pharmacokinetics and pharmacogenetics of this drug. Certain correlation was seen with oral amiodarone therapy, in others, plasma amiodarone levels were unrelated to therapeutic response and showed no correlation with changes in electrocardiogram or electrophysiological parametres. Several studies show that plasma concentration ranging between 0.5 and 2.5 mg/L appears to be the most effective, others demonstrate no difference between responders and non-responders. One way of interpreting plasma levels is to establish an individual patient´s effective concentration. Therapeutic drug monitoring can contribute to determining optimal concentration.
Topics: Adult; Aged; Aged, 80 and over; Amiodarone; Anti-Arrhythmia Agents; Arrhythmias, Cardiac; Dose-Response Relationship, Drug; Female; Humans; Male; Middle Aged
PubMed: 28414390
DOI: 10.5507/bp.2017.016